Paeds Cases · endocrinology-diabetes-and-growth
Endocrine emergencies: integrated approach — structured clinical encounter
Structured encounter: a 4-year-old with new-onset severe DKA who develops cerebral injury warning signs during treatment, covering recognition, first-hour fluids and insulin, cerebral injury treatment and the family conversation.
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Recognition and the bedside tests
The candidate notes that DKA symptoms are non-specific, and that ISPAD advises considering a fingerstick glucose in children with rapid breathing, or vomiting and abdominal pain without diarrhoea. The candidate confirms DKA with all three ISPAD criteria: glucose above 11 mmol/L, venous pH below 7.3 or bicarbonate below 18 mmol/L, and ketonaemia. A pH below 7.1 grades this DKA as severe. [1]
The candidate notes ISPAD data: very young children and those of underserved ethnic groups are at increased risk of presenting with DKA at diagnosis of type 1 diabetes. [1]
References3ShowHide
- [1]Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric diabetes, 2022.PMID 36250645
- [13]Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. The New England journal of medicine, 2001.PMID 11172153
- [14]Muir AB, Quisling RG, Yang MC, et al. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes care, 2004.PMID 15220225